“Real-Time” Monitoring of Under-Five Mortality: Lessons for Strengthened Vital Statistics Systems

Bryce, Jennifer; Amouzou, Agbessi; Victora, Cesar G; Jones, Gareth; Silva, Romesh; Hill, Kenneth; Black, Robert E.

doi:10.1371/journal.pmed.1001904

Cited by 7 publications

(9 citation statements)

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“…In addition to controls and checks programmed in the CAPI system, careful training and field supervision of interviewers were used to try to minimize errors known to occur during the collection of FPH data, e.g., errors in age and date declaration, misclassifications of stillbirths as neonatal deaths (and vice-versa), and omission of births and deaths [ 9 , 10 , 25 , 26 ]. As mentioned elsewhere [ 14 ], there were initial concerns about the quality of the FPH data collected in Ghana. In this paper, we thus report extensive analyses of potential errors and inconsistencies in such data (see below).…”

Section: Methodsmentioning

confidence: 99%

“…RMM methods included: community-based reporting on vital events, various adjustments to HMIS data, as well as rapid household survey methods (e.g., summary birth histories). They were tested in several Sub-Saharan African countries [ 14 ], with heterogeneous results [ 15 ]. In Ethiopia and Malawi, for example, community-based reports of vital events collected by paid workers under-estimated mortality levels compared to survey data [ 16 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Using community-based reporting of vital events to monitor child mortality: Lessons from rural Ghana

et al. 2018

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BackgroundReducing neonatal and child mortality is a key component of the health-related sustainable development goal (SDG), but most low and middle income countries lack data to monitor child mortality on an annual basis. We tested a mortality monitoring system based on the continuous recording of pregnancies, births and deaths by trained community-based volunteers (CBV).Methods and findingsThis project was implemented in 96 clusters located in three districts of the Northern Region of Ghana. Community-based volunteers (CBVs) were selected from these clusters and were trained in recording all pregnancies, births, and deaths among children under 5 in their catchment areas. Data collection lasted from January 2012 through September 2013. All CBVs transmitted tallies of recorded births and deaths to the Ghana Birth and deaths registry each month, except in one of the study districts (approximately 80% reporting). Some events were reported only several months after they had occurred. We assessed the completeness and accuracy of CBV data by comparing them to retrospective full pregnancy histories (FPH) collected during a census of the same clusters conducted in October-December 2013. We conducted all analyses separately by district, as well as for the combined sample of all districts. During the 21-month implementation period, the CBVs reported a total of 2,819 births and 137 under-five deaths. Among the latter, there were 84 infant deaths (55 neonatal deaths and 29 post-neonatal deaths). Comparison of the CBV data with FPH data suggested that CBVs significantly under-estimated child mortality: the estimated under-5 mortality rate according to CBV data was only 2/3 of the rate estimated from FPH data (95% Confidence Interval for the ratio of the two rates = 51.7 to 81.4). The discrepancies between the CBV and FPH estimates of infant and neonatal mortality were more limited, but varied significantly across districts.ConclusionsIn northern Ghana, a community-based data collection systems relying on volunteers did not yield accurate estimates of child mortality rates. Additional implementation research is needed to improve the timeliness, completeness and accuracy of such systems. Enhancing pregnancy monitoring, in particular, may be an essential step to improve the measurement of neonatal mortality.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Using community-based reporting of vital events to monitor child mortality: Lessons from rural Ghana

et al. 2018

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“…The scope of this study is limited for several reasons. First, results are based on age profiles constructed using full-life histories from survey data, which are subject to several sources of error; rather than high quality vital registration systems, which are inexistent or deficient in the countries included in our study (Bryce et al 2016). Second, we used different measures of inequality to improve the robustness of our analysis as they differ in their underlying properties and sensitivity to age-specific mortality change (van Raalte and Caswell 2013).…”

Section: Discussionmentioning

confidence: 99%

Pursuing the limits of child survival in the most and least developed countries

Mejía‐Guevara

Zuo

Mortensen

et al. 2019

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This study analyzes compression, convergence, and age-inequality of under-5 mortality patterns in sub-Saharan Africa (SSA). We hypothesize that accelerated reductions in under-5 death rates are associated with substantive changes in the age distribution and variation of deaths. To analyze age variation rather than mean values for under-5 deaths, we adapted indicators of compression, convergence, and inequality that were developed for the total length of life. We constructed conditional life-table death rates for under-5 age children from 31 SSA countries from 1990 to 2017, using retrospective data from the Demographic and Health Surveys for these countries. We used these to identify heterogeneities across countries in the age patterns of mortality, the pace of mortality decline, and convergence. Our results revealed stronger evidence of reduced age-inequality in countries experiencing large or accelerated reductions in average under-5 mortality levels (with annual reduction rates [ARR]≥3.2%), in comparison with those showing stagnant or slower mortality decline (ARR<3.2%). Data quality issues derived from the use of survey data to approximate age patterns of mortality may affect the accuracy of the estimates and represent a limitation of this study.

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“…The findings of this study should be judge in light of several limitations. First, the gold standard for the analysis of mortality in more developed countries relies on the existence of high quality vital registration systems, but those systems are inexistent or deficient in the countries included in our study (50). Second, this study relies on self-reported information from life histories available in nationally-representative surveys, which are subject to several sources of error.…”

Section: Discussionmentioning

confidence: 99%

Age Distribution, Trends, and Forecasts of Under-5 Mortality in Sub-Saharan Africa

Mejía‐Guevara

Zuo

Bendavid

et al. 2018

Preprint

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Background: Despite the sharp decline in global under-5 deaths since 1990, uneven progress has been achieved across and within countries. In Sub-Saharan Africa, the Millennium Development Goals targets for child mortality were met only by a few countries, and recently new targets were set in goals for Sustainable Development that include the eradication of preventable deaths by reducing neonatal and under-5 mortality rates to at least as low 12 and 25 per 1000 live births by 2030, respectively. As the reduction of preventable deaths has a direct impact on their age distribution, the foci of this study are assessing age patterns, trends over time, and forecasts of mortality rates in Sub-Saharan Africa. Methods and findings: Data came from 104 nationally-representative Demographic and HealthSurveys with full birth histories from 31 Sub-Saharan African countries from 1990 to 2016 (a total of 448 country-years of data). We assessed the distribution of age at death through the following demographic model. First, we used a direct method for the estimation of death rates with full-birth histories from survey data to construct age profiles of under-5 mortality on a monthly basis. Second, a two-dimensional P-spline approach was used to smooth out raw estimates of death rates by age and time. Third, a variant of the Lee-Carter model, designed for populations with limited data, was used to fit and forecast age profiles of mortality. We used mortality estimates from the United Nations Inter-agency group for Child Mortality Estimation to adjust, validate and minimize the risk of bias in survival, truncation, and recall in mortality estimation.Our study has three salient findings. First, we observe a monotonous decline of death rates at every age in most countries, but with notable differences in the age-patterns over time. Second, our projections of continued decline of child mortality differ from existing estimates from the United Nations Inter-agency group for Child Mortality Estimation in 5 countries for both neonatal and under-5 mortality. Finally, we predict that only 5 countries (Guinea, Liberia, Rwanda, Tanzania, and Uganda) are on track to achieve the sustainable development goal targets on child mortality by 2030. Poor data quality issues that include bias in the report of births and deaths, or age heaping, remain a limitation of this study. Conclusions:This study is the first to combine full birth history data and mortality estimates from external reliable sources to model age patterns of under-5 mortality across time in Sub-Saharan Africa. We demonstrate that countries with a rapid pace of mortality reduction across ages would be more likely to achieve the sustainable development goal targets of child mortality reduction. Our mortality model predicts that if neonatal and under-5 deaths decline at the rates observed during the last 25 years, only 5 countries would reach those targets by 2030, 15 would achieve them between 2030 and 2050, and 11 afterwards.

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“Real-Time” Monitoring of Under-Five Mortality: Lessons for Strengthened Vital Statistics Systems

Abstract: Bryce and colleagues, reflect on lessons that can be learned from the Real-Time Monitoring of Under-Five Mortality Collection.

Cited by 7 publications

References 13 publications

Using community-based reporting of vital events to monitor child mortality: Lessons from rural Ghana

Using community-based reporting of vital events to monitor child mortality: Lessons from rural Ghana

Pursuing the limits of child survival in the most and least developed countries

Age Distribution, Trends, and Forecasts of Under-5 Mortality in Sub-Saharan Africa

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